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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT �\ <br /> 304 EWEBER A VE-3""FL-$TOCKTON CA 95282 - (204)468-3420 <br /> SAN JOAQUIN COUNTY ENIORONMENTAL HEALTH DEPARTMENT <br /> a t CALL(209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM.DATE ISSUED" <br /> NON-KEFUNDABLE PERMIT �/vP <br /> S w <br /> JOB ADDRESS /.� _Z�O PwRCELStzr 6-2- <br /> CROSS STREET �T^`y • -- APN J 1 <br /> t U <br /> /!"�,✓ %`:,Ar/6- - pw)NE2a9—Q3 3d <br /> OWNER NAME --�(j - "-�--- <br /> _ r <br /> O/ i9-SSo Q 0 CITY/STATFILIP <br /> OWNER ADDRESS <br /> PHONE <br /> CONTRACTOR --_ <br /> 0, CI1YiSTATElZIP <br /> CONTRACTOR ADDRESS- . <br /> LICENSE -42 C-36 OTHER__-- <br /> NUM ExPIRATION DATE <br /> WATER TABLE DEPTH: <br /> ft GEOGRAPHICAL INFORMATION: Coordinates X___ Y <br /> ❑ FERC TEST # BUII DING PERMIT# LAND USE APPLICATION# —. <br /> ❑ REPAIR/ADDITfON CI ENGINEER DESIGNED/ALTERNATIVE <br /> TYPE OF WORK: ❑ NEW MSTALL-TION DESTRUCTION��Arim�C — <br /> . ❑_ REPLACEMENT _ - - <br /> ❑ COMMERCIAL " ❑ OTHER <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE NUMBEROFEMPLOVEES: _ <br /> NUMBER OF LIVING UNITS:- NUMBER OF BEDROOMS:-Z <br /> — <br /> LI <br /> -_ gal #OF COMPARTMENTS <br /> ❑ SEPTIC TANK TYPF.`MFG_. <br /> CAPACITY Bal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPFIMFG ft <br /> ft FOUNDATION ft LINEPROPERTY LE <br /> D PKG TX PLANT DISTANCE TO NEAREST' WELL —__ , <br /> ❑ 11 TYPE OF PUMP <br /> ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LIFT STATION SIZE <br /> _- #OF LINES LENGTH OF LINES____ fl . <br /> (3 LEACH LINES (3 LEACHING CHAMBERS R PROPERTY LINEft <br /> DISTANCE TO NEAREST WELL - ft FOUNDATION <br /> ft LENGTH ft <br /> DEPTH <br /> C3 FILTER BED WIDTH R PROPERTY LINE R <br /> DISTANCE TO NEAREST WELL <br /> f) FOUNDATION <br /> ❑ MOUNDED wIDTH fl LENGTH <br /> R DEPTH_ ft <br /> R FOUNDATION R PROPERTY LINE ft <br /> DISTANCE TO NEAREST WELL '. A R <br /> ft LENGTH ft DEPTH <br /> 13 SUMPS WIDTH A.. ft PRUPERTY LINE <br /> DISTANCE TO NEE AREST WELL fl FOUNDATION <br /> . ft LENGTH' - ft DEPIH ft <br /> CI DISPOSAL PONDS WIDTH R PROPERTY LINE <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> R DEPTH ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH I <br /> DISTANCE TO NEAREST WELL <br /> R FOUNDATION R PROPERTY LINE fl <br /> _ <br /> +� I HERESY CERTIFY THAT!HAVE PREPARED THIS APPLtCATtON AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY s i <br /> ORDINANCES..STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY- <br /> ORDINANCES, <br /> ' <br /> NIMUM 24 ADVANCE NOTICE REQUIRED FOR INSPECT(ONS-PLEASE CALL ON)953-7697 <br /> SIGNED <br /> TITLE e^/m .�- DATE — <r <br /> y � <br /> I <br /> m 1 <br /> 1 <br /> b <br /> -777 <br /> E 7 <br /> N <br /> /J. _ ART_MENT US NLYA6 <br /> Application Accepted Area Empbyee ID#6aC; S e <br /> Final Inspection By_ Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Dept of 3 P. !Sump Soil Character. <br /> COMMENTS _ g .wt y?r�erre <br /> PE Sc Rceeived Chech#/ RRt Date erm !inv� <br /> Code INFO B Remitted Service R nest# <br /> 16 �5 <br /> ONSITE WASTEWATER PERMIT <br /> 42-02-001 <br /> I2i22n003 <br />